| 1. |
- Khotyaintsev, Yuri V., et al.
(författare)
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Electron jet of asymmetric reconnection
- 2016
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Ingår i: Geophysical Research Letters. - : Blackwell Publishing. - 0094-8276 .- 1944-8007. ; 43:11, s. 5571-5580
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Tidskriftsartikel (refereegranskat)abstract
- We present Magnetospheric Multiscale observations of an electron-scale current sheet and electron outflow jet for asymmetric reconnection with guide field at the subsolar magnetopause. The electron jet observed within the reconnection region has an electron Mach number of 0.35 and is associated with electron agyrotropy. The jet is unstable to an electrostatic instability which generates intense waves with E-vertical bar amplitudes reaching up to 300mVm(-1) and potentials up to 20% of the electron thermal energy. We see evidence of interaction between the waves and the electron beam, leading to quick thermalization of the beam and stabilization of the instability. The wave phase speed is comparable to the ion thermal speed, suggesting that the instability is of Buneman type, and therefore introduces electron-ion drag and leads to braking of the electron flow. Our observations demonstrate that electrostatic turbulence plays an important role in the electron-scale physics of asymmetric reconnection.
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| 2. |
- Le Contel, O., et al.
(författare)
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Lower Hybrid Drift Waves and Electromagnetic Electron Space-Phase Holes Associated With Dipolarization Fronts and Field-Aligned Currents Observed by the Magnetospheric Multiscale Mission During a Substorm
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 122:12, s. 12236-12257
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Tidskriftsartikel (refereegranskat)abstract
- We analyze two ion scale dipolarization fronts associated with field-aligned currents detected by the Magnetospheric Multiscale mission during a large substorm on 10 August 2016. The first event corresponds to a fast dawnward flow with an antiparallel current and could be generated by the wake of a previous fast earthward flow. It is associated with intense lower hybrid drift waves detected at the front and propagating dawnward with a perpendicular phase speed close to the electric drift and the ion thermal velocity. The second event corresponds to a flow reversal: from southwward/dawnward to northward/duskward associated with a parallel current consistent with a brief expansion of the plasma sheet before the front crossing and with a smaller lower hybrid drift wave activity. Electromagnetic electron phase-space holes are detected near these low-frequency drift waves during both events. The drift waves could accelerate electrons parallel to the magnetic field and produce the parallel electron drift needed to generate the electron holes. Yet we cannot rule out the possibility that the drift waves are produced by the antiparallel current associated with the fast flows, leaving the source for the electron holes unexplained.
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| 3. |
- Norgren, Cecilia, et al.
(författare)
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Finite gyroradius effects in the electron outflow of asymmetric magnetic reconnection
- 2016
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Ingår i: Geophysical Research Letters. - : Blackwell Publishing. - 0094-8276 .- 1944-8007. ; 43:13, s. 6724-6733
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Tidskriftsartikel (refereegranskat)abstract
- We present observations of asymmetric magnetic reconnection showing evidence of electron demagnetization in the electron outflow. The observations were made at the magnetopause by the four Magnetospheric Multiscale (MMS) spacecraft, separated by approximate to 15km. The reconnecting current sheet has negligible guide field, and all four spacecraft likely pass close to the electron diffusion region just south of the X line. In the electron outflow near the X line, all four spacecraft observe highly structured electron distributions in a region comparable to a few electron gyroradii. The distributions consist of a core with T-vertical bar>T and a nongyrotropic crescent perpendicular to the magnetic field. The crescents are associated with finite gyroradius effects of partly demagnetized electrons. These observations clearly demonstrate the manifestation of finite gyroradius effects in an electron-scale reconnection current sheet.
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| 4. |
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| 5. |
- Fuselier, S. A., et al.
(författare)
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Large-scale characteristics of reconnection diffusion regions and associated magnetopause crossings observed by MMS
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - 2169-9380 .- 2169-9402. ; 122:5, s. 5466-5486
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Tidskriftsartikel (refereegranskat)abstract
- The Magnetospheric Multiscale (MMS) mission was designed to make observations in the very small electron diffusion region (EDR), where magnetic reconnection takes place. From a data set of over 4500 magnetopause crossings obtained in the first phase of the mission, MMS had encounters near or within 12 EDRs. These 12 events and associated magnetopause crossings are considered as a group to determine if they span the widest possible range of external and internal conditions (i.e., in the solar wind and magnetosphere). In addition, observations from MMS are used to determine if there are multiple X-lines present and also to provide information on X-line location relative to the spacecraft. These 12 events represent nearly the widest possible range of conditions at the dayside magnetopause. They occur over a wide range of local times and magnetic shear angles between the magnetosheath and magnetospheric magnetic fields. Most show evidence for multiple reconnection sites.
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| 6. |
- Graham, Daniel B., et al.
(författare)
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Electron currents and heating in the ion diffusion region of asymmetric reconnection
- 2016
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Ingår i: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 43:10, s. 4691-4700
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Tidskriftsartikel (refereegranskat)abstract
- In this letter the structure of the ion diffusion region of magnetic reconnection at Earth's magnetopause is investigated using the Magnetospheric Multiscale (MMS) spacecraft. The ion diffusion region is characterized by a strong DC electric field, approximately equal to the Hall electric field, intense currents, and electron heating parallel to the background magnetic field. Current structures well below ion spatial scales are resolved, and the electron motion associated with lower hybrid drift waves is shown to contribute significantly to the total current density. The electron heating is shown to be consistent with large-scale parallel electric fields trapping and accelerating electrons, rather than wave-particle interactions. These results show that sub-ion scale processes occur in the ion diffusion region and are important for understanding electron heating and acceleration.
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| 7. |
- Graham, Daniel B., et al.
(författare)
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Lower hybrid waves in the ion diffusion and magnetospheric inflow regions
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 122:1, s. 517-533
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Tidskriftsartikel (refereegranskat)abstract
- The role and properties of lower hybrid waves in the ion diffusion region and magnetospheric inflow region of asymmetric reconnection are investigated using the Magnetospheric Multiscale (MMS) mission. Two distinct groups of lower hybrid waves are observed in the ion diffusion region and magnetospheric inflow region, which have distinct properties and propagate in opposite directions along the magnetopause. One group develops near the ion edge in the magnetospheric inflow, where magnetosheath ions enter the magnetosphere through the finite gyroradius effect and are driven by the ion-ion cross-field instability due to the interaction between the magnetosheath ions and cold magnetospheric ions. This leads to heating of the cold magnetospheric ions. The second group develops at the sharpest density gradient, where the Hall electric field is observed and is driven by the lower hybrid drift instability. These drift waves produce cross-field particle diffusion, enabling magnetosheath electrons to enter the magnetospheric inflow region thereby broadening the density gradient in the ion diffusion region.
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| 8. |
- Vaivads, Andris, et al.
(författare)
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Turbulence Heating ObserveR - satellite mission proposal
- 2016
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Ingår i: JOURNAL OF PLASMA PHYSICS. - 0022-3778. ; 82
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Tidskriftsartikel (refereegranskat)abstract
- The Universe is permeated by hot, turbulent, magnetized plasmas. Turbulent plasma is a major constituent of active galactic nuclei, supernova remnants, the intergalactic and interstellar medium, the solar corona, the solar wind and the Earth's magnetosphere, just to mention a few examples. Energy dissipation of turbulent fluctuations plays a key role in plasma heating and energization, yet we still do not understand the underlying physical mechanisms involved. THOR is a mission designed to answer the questions of how turbulent plasma is heated and particles accelerated, how the dissipated energy is partitioned and how dissipation operates in different regimes of turbulence. THOR is a single-spacecraft mission with an orbit tuned to maximize data return from regions in near-Earth space - magnetosheath, shock, foreshock and pristine solar wind - featuring different kinds of turbulence. Here we summarize the THOR proposal submitted on 15 January 2015 to the 'Call for a Medium-size mission opportunity in ESAs Science Programme for a launch in 2025 (M4)'. THOR has been selected by European Space Agency (ESA) for the study phase.
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| 9. |
- Benterud, T, et al.
(författare)
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N-Acetylcysteine Amide Exerts Possible Neuroprotective Effects in Newborn Pigs after Perinatal Asphyxia
- 2017
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Ingår i: Neonatology. - : S. Karger AG. - 1661-7819 .- 1661-7800. ; 111:1, s. 12-21
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> Perinatal asphyxia and ensuing reoxygenation change the antioxidant capacity of cells and organs. <b><i>Objectives:</i></b> To analyze the neuroprotective effect of the antioxidant N-acetylcysteine amide (NACA) after perinatal hypoxia-reoxygenation with an emphasis on proinflammatory cytokines and the transcription factor NF-κB in the prefrontal cortex of neonatal pigs. <b><i>Methods:</i></b> Twenty-nine newborn pigs, aged 12-36 h, were subjected to global hypoxia and hypercapnia. One sham-operated group (n = 5) and 2 experimental groups (n = 12) were exposed to 8% oxygen, until the base excess was -20 mmol/l or the mean arterial blood pressure fell to <20 mm Hg (asphyxia with NACA or saline). The pigs were observed for 9.5 h after hypoxia. Samples of prefrontal cortex and plasma were analyzed. <b><i>Results:</i></b> Cortex: there was no significant difference in mRNA expression between the intervention groups regarding IL-1β, IL6, TNFα, MMP2, MMP9 or IL18. Pigs exposed to hypoxia-reoxygenation and treatment with NACA (NACA-pigs) had a significantly lower protein concentration of IL-1β than pigs treated with saline (placebo controls), i.e. 8.8 ± 3.9 versus 16.8 ± 10.5 pg/mg protein (p = 0.02). The activation of the transcription factor NF-κB (measured as the fold-change of phosphorylated p65<sup>Ser 536</sup>), was reduced in the NACA-pigs when compared to the placebo controls (5.2 ± 4.3 vs. 16.0 ± 13.5; p = 0.02). No difference between the intervention groups regarding brain histopathology or in the levels of 8-oxoguanine measured in the prefrontal cortex were observed. Plasma: the NACA-pigs had a stronger reduction of TNFα in the first 30 min following asphyxia compared with the placebo controls, i.e. 36 (30-44) versus 24 (14-32)% (p = 0.01). <b><i>Conclusion:</i></b> The reduced levels of the pivotal inflammatory markers IL-1β and TNFα and the transcription factor NF-κB may indicate that NACA has possible neuroprotective effects after perinatal asphyxia.
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| 10. |
- Graham, Daniel B., et al.
(författare)
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Instability of Agyrotropic Electron Beams near the Electron Diffusion Region
- 2017
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Ingår i: Physical Review Letters. - : American Physical Society. - 0031-9007 .- 1079-7114. ; 119:2
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Tidskriftsartikel (refereegranskat)abstract
- During a magnetopause crossing the Magnetospheric Multiscale spacecraft encountered an electron diffusion region (EDR) of asymmetric reconnection. The EDR is characterized by agyrotropic beam and crescent electron distributions perpendicular to the magnetic field. Intense upper-hybrid (UH) waves are found at the boundary between the EDR and magnetosheath inflow region. The UH waves are generated by the agyrotropic electron beams. The UH waves are sufficiently large to contribute to electron diffusion and scattering, and are a potential source of radio emission near the EDR. These results provide observational evidence of wave-particle interactions at an EDR, and suggest that waves play an important role in determining the electron dynamics.
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| 11. |
- Larzon, Thomas, 1950-, et al.
(författare)
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Editor's choice : a randomized controlled trial of the fascia suture technique compared with a suture-mediated closure device for femoral arterial closure after endovascular aortic repair
- 2015
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : W.B. Saunders Ltd. - 1078-5884 .- 1532-2165. ; 49:2, s. 166-173
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to investigate whether the fascia suture technique (FST) can reduce access closure time and procedural costs compared with the Prostar technique (Prostar) in patients undergoing endovascular aortic repair and to evaluate the short- and mid-term outcomes of both techniques.Methods: In this two center trial, 100 patients were randomized to access closure by either FST or Prostar between June 2006 and December 2009. The primary endpoint was access closure time. Secondary outcome measures included access related costs and evaluation of the short- and mid-term complications. Evaluation was performed pen- and post-operatively, at discharge, at 30 days and at 6 months follow up.Results: The median access closure time was 12.4 minutes for FST and 19.9 minutes for Prostar (p < .001). Prostar required a 54% greater procedure time than FST, mean ratio 1.54 (95% Cl 1.25-1.90, p < .001) according to regression analysis. Adjusted for operator experience the mean ratio was 1.30 (95% Cl 1.09-1.55, p = .005) and for patient body mass index 1.59 (95% Cl 1.28-1.96, p < .001). The technical failure rate for operators at proficiency level was 5% (2/40) compared with 28% (17/59) for those at the basic level (p = .003). The proficiency level group had a technical failure rate of 4% (1/26) for FST and 7% (1/14) for Prostar, p = 1.00, while corresponding rates for the basic level group were 27% (6/22) for FST and 30% (11/37) for Prostar (p = .84). There was a significant difference in cost in favor. of FST, with a median difference of (sic)800 (95% Cl 710-927, p < .001). Conclusions: In aortic endovascular repair FST is a faster and cheaper technique than the Prostar technique.
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| 12. |
- Li, Wenya, et al.
(författare)
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Kinetic evidence of magnetic reconnection due to Kelvin-Helmholtz waves
- 2016
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Ingår i: Geophysical Research Letters. - : Blackwell Publishing. - 0094-8276 .- 1944-8007. ; 43:11, s. 5635-5643
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Tidskriftsartikel (refereegranskat)abstract
- The Kelvin-Helmholtz (KH) instability at the Earth's magnetopause is predominantly excited during northward interplanetary magnetic field (IMF). Magnetic reconnection due to KH waves has been suggested as one of the mechanisms to transfer solar wind plasma into the magnetosphere. We investigate KH waves observed at the magnetopause by the Magnetospheric Multiscale (MMS) mission; in particular, we study the trailing edges of KH waves with Alfvenic ion jets. We observe gradual mixing of magnetospheric and magnetosheath ions at the boundary layer. The magnetospheric electrons with energy up to 80keV are observed on the magnetosheath side of the jets, which indicates that they escape into the magnetosheath through reconnected magnetic field lines. At the same time, the low-energy (below 100eV) magnetosheath electrons enter the magnetosphere and are heated in the field-aligned direction at the high-density edge of the jets. Our observations provide unambiguous kinetic evidence for ongoing reconnection due to KH waves.
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| 13. |
- Voros, Z., et al.
(författare)
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MMS Observation of Magnetic Reconnection in the Turbulent Magnetosheath
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - : AMER GEOPHYSICAL UNION. - 2169-9380 .- 2169-9402. ; 122:11, s. 11442-11467
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we use the full armament of the MMS (Magnetospheric Multiscale) spacecraft to study magnetic reconnection in the turbulent magnetosheath downstream of a quasi-parallel bow shock. Contrarily to the magnetopause and magnetotail cases, only a few observations of reconnection in the magnetosheath have been reported. The case study in this paper presents, for the first time, both fluid-scale and kinetic-scale signatures of an ongoing reconnection in the turbulent magnetosheath. The spacecraft are crossing the reconnection inflow and outflow regions and the ion diffusion region (IDR). Inside the reconnection outflows D shape ion distributions are observed. Inside the IDR mixing of ion populations, crescent-like velocity distributions and ion accelerations are observed. One of the spacecraft skims the outer region of the electron diffusion region, where parallel electric fields, energy dissipation/conversion, electron pressure tensor agyrotropy, electron temperature anisotropy, and electron accelerations are observed. Some of the difficulties of the observations of magnetic reconnection in turbulent plasma are also outlined.
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| 14. |
- Yordanova, Emiliya, et al.
(författare)
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Electron scale structures and magnetic reconnection signatures in the turbulent magnetosheath
- 2016
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Ingår i: Geophysical Research Letters. - : Blackwell Publishing. - 0094-8276 .- 1944-8007. ; 43:12, s. 5969-5978
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Tidskriftsartikel (refereegranskat)abstract
- Collisionless space plasma turbulence can generate reconnecting thin current sheets as suggested by recent results of numerical magnetohydrodynamic simulations. The Magnetospheric Multiscale (MMS) mission provides the first serious opportunity to verify whether small ion-electron-scale reconnection, generated by turbulence, resembles the reconnection events frequently observed in the magnetotail or at the magnetopause. Here we investigate field and particle observations obtained by the MMS fleet in the turbulent terrestrial magnetosheath behind quasi-parallel bow shock geometry. We observe multiple small-scale current sheets during the event and present a detailed look of one of the detected structures. The emergence of thin current sheets can lead to electron scale structures. Within these structures, we see signatures of ion demagnetization, electron jets, electron heating, and agyrotropy suggesting that MMS spacecraft observe reconnection at these scales.
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| 15. |
- André, Mats, et al.
(författare)
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Lower hybrid waves at comet 67P/Churyumov-Gerasimenko
- 2017
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Ingår i: Monthly notices of the Royal Astronomical Society. - : OXFORD UNIV PRESS. - 0035-8711 .- 1365-2966. ; 469, s. S29-S38
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Tidskriftsartikel (refereegranskat)abstract
- We investigate the generation of waves in the lower hybrid frequency range by density gradients in the near plasma environment of comet 67P/Churyumov-Gerasimenko. When the plasma is dominated by water ions from the comet, a situation with magnetized electrons and unmagnetized ions is favourable for the generation of lower hybrid waves. These waves can transfer energy between ions and electrons and reshape the plasma environment of the comet. We consider cometocentric distances out to a few hundred km. We find that when the electron motion is not significantly interrupted by collisions with neutrals, large average gradients within tens of km of the comet, as well as often observed local large density gradients at larger distances, are often likely to be favourable for the generation of lower hybrid waves. Overall, we find that waves in the lower hybrid frequency range are likely to be common in the near plasma environment.
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| 16. |
- André, Mats, et al.
(författare)
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Magnetic reconnection and modification of the Hall physics due to cold ions at the magnetopause
- 2016
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Ingår i: Geophysical Research Letters. - : Blackwell Publishing. - 0094-8276 .- 1944-8007. ; 43:13, s. 6705-6712
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Tidskriftsartikel (refereegranskat)abstract
- Observations by the four Magnetospheric Multiscale spacecraft are used to investigate the Hall physics of a magnetopause magnetic reconnection separatrix layer. Inside this layer of currents and strong normal electric fields, cold (eV) ions of ionospheric origin can remain frozen-in together with the electrons. The cold ions reduce the Hall current. Using a generalized Ohm's law, the electric field is balanced by the sum of the terms corresponding to the Hall current, the vxB drifting cold ions, and the divergence of the electron pressure tensor. A mixture of hot and cold ions is common at the subsolar magnetopause. A mixture of length scales caused by a mixture of ion temperatures has significant effects on the Hall physics of magnetic reconnection.
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| 17. |
- Berger, J. S., et al.
(författare)
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Design and rationale for the Effects of Ticagrelor and Clopidogrel in Patients with Peripheral Artery Disease (EUCLID) trial
- 2016
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703. ; 175, s. 86-93
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Tidskriftsartikel (refereegranskat)abstract
- Background Despite overwhelming data demonstrating the efficacy of antiplatelet therapy in heart disease and stroke, data in peripheral artery disease (PAD) are less compelling. Aspirin has modest evidence supporting a reduction in cardiovascular events in patients with PAD, whereas clopidogrel monotherapy may be more effective in PAD. Ticagrelor, a potent, reversibly binding P2Y(12) receptor antagonist, is beneficial in patients with acute coronary syndrome and prior myocardial infarction. The EUCLID trial is designed to address the need for effective antiplatelet therapy in PAD to decrease the risk of cardiovascular events. Study design EUCLID is a randomized, double-blind, parallel-group, multinational clinical trial designed to evaluate the efficacy and safety of ticagrelor compared with clopidogrel for the prevention of major adverse cardiovascular events in subjects with symptomatic PAD. Subjects with established PAD will be randomized in a 1: 1 fashion to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily. The primary end point is a composite of cardiovascular death, myocardial infarction, or ischemic stroke. Other end points address limb events including acute leg ischemia, need for revascularization, disease progression by ankle-brachial index, and quality of life. The primary safety objective is Thrombolysis in Myocardial Infarction-defined major bleeding. Recruitment began in December 2012 and was completed in March 2014; 13,887 patients were randomized. The trial will continue until at least 1,364 adjudicated primary end points occur. Conclusions The EUCLID study is investigating whether treatment with ticagrelor versus clopidogrel, given as antiplatelet monotherapy, will reduce the incidence of cardiovascular and limb-specific events in patients with symptomatic PAD.
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| 18. |
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| 19. |
- Graham, Daniel B., et al.
(författare)
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Universality of Lower Hybrid Waves at Earth's Magnetopause
- 2019
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Ingår i: Journal of Geophysical Research - Space Physics. - : John Wiley & Sons. - 2169-9380 .- 2169-9402. ; 124:11, s. 8727-8760
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Tidskriftsartikel (refereegranskat)abstract
- Waves around the lower hybrid frequency are frequently observed at Earth's magnetopause and readily reach very large amplitudes. Determining the properties of lower hybrid waves is crucial because they are thought to contribute to electron and ion heating, cross‐field particle diffusion, anomalous resistivity, and energy transfer between electrons and ions. All these processes could play an important role in magnetic reconnection at the magnetopause and the evolution of the boundary layer. In this paper, the properties of lower hybrid waves at Earth's magnetopause are investigated using the Magnetospheric Multiscale mission. For the first time, the properties of the waves are investigated using fields and direct particle measurements. The highest‐resolution electron moments resolve the velocity and density fluctuations of lower hybrid waves, confirming that electrons remain approximately frozen in at lower hybrid wave frequencies. Using fields and particle moments, the dispersion relation is constructed and the wave‐normal angle is estimated to be close to 90° to the background magnetic field. The waves are shown to have a finite parallel wave vector, suggesting that they can interact with parallel propagating electrons. The observed wave properties are shown to agree with theoretical predictions, the previously used single‐spacecraft method, and four‐spacecraft timing analyses. These results show that single‐spacecraft methods can accurately determine lower hybrid wave properties.
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| 20. |
- Gutierrez, J. A., et al.
(författare)
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Polyvascular Disease and Risk of Major Adverse Cardiovascular Events in Peripheral Artery Disease A Secondary Analysis of the EUCLID Trial
- 2018
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Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 1:7
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE The effect of polyvascular disease on cardiovascular outcomes in the background of peripheral artery disease (PAD) is unclear. OBJECTIVE To determine the risk of ischemic events (both cardiac and limb) among patients with PAD and polyvascular disease. DESIGN, SETTING, AND PARTICIPANTS In this post hoc secondary analysis of the international Examining Use of Ticagrelor in Peripheral Artery Disease (EUCLID) trial, outcomes were compared among 13 885 enrolled patients with PAD alone, PAD + coronary artery disease (CAD), PAD + cerebrovascular disease (CVD), and PAD + CAD + CVD. Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with polyvascular disease and outcomes, and intention-to-treat analysis was performed. The EUCLID trial was conducted from December 31, 2012, to March 7, 2014; the present post hoc analysis was performed from June 1, 2017, to February 5, 2018. INTERVENTIONS EUCLID evaluated ticagrelor vs clopidogrel in preventing major adverse cardiac events (cardiovascular death, myocardial infarction [MI], or ischemic stroke) and major bleeding in patients with PAD. MAIN OUTCOMES AND MEASURES The primary end point was a composite of cardiovascular death, MI, or ischemic stroke. Key secondary end points included the individual components of the primary end point and acute limb ischemia leading to hospitalization, major amputation, and lower-extremity revascularization. The primary end point of Thrombolysis in Myocardial Infarction (TIMI) major bleeding was also evaluated. RESULTS The EUCLID trial randomized 13 885 patients with a median age of 66 years (interquartile range, 60-73 years), of whom 3888 (28.0%) were women. At baseline, 7804 patients (56.2%) had PAD alone; 2639 (19.0%) had PAD + CAD; 2049 (14.8%) had PAD + CVD; and 1393 (10.0%) had PAD + CAD + CVD. Compared with patients with isolated PAD, the adjusted hazard ratios (aHRs) for major adverse cardiac events were 1.34 (95% CI, 1.15-1.57; P < .001) for PAD + CVD, 1.65 (95% CI, 1.43491; P < .001) for PAD + CAD, and 1.99 (95% CI, 1.69-2.34; P < .001)for PAD + CAD + CVD. The aHRs for lower-extremity revascularization were 1.17 (95% CI, 1.03-1.34; P = .01) for PAD + CAD, 1.17 (95% CI, 1.02-1.35; P = .02) for PAD + CVD. and 1.34 (95% CI, 1.15-1.57; P < .001) for PAD + CAD + CVD. Polyvascular disease was not associated with an increased risk of acute limb ischemia (aHR for PAD + CVD, 0.91; 95% CI, 0.62-1.34, P = .63; PAD + CAD, 0.93; 95% CI, 0.64-1.34. P = .69; and PAD + CAD + CVD, 0.98; 95% CI, 0.63-1.53, P = .93), major amputation (aHR for PAD + CVD, 0.83; 95% CI, 0.541.27, P = .40; PAD + CAD, 0.74; 95% CI, 0.47-1.16, P = .19; and PAD + CAD + CVD, 1.12; 95% CI, 0.691.80, P = .65), or TI MI major bleeding (PAD + CVD, 0.98; 0.66-1.44, P = .91; PAD + CAD, 1.04; 0.741.48, P = .81; and PAD + CAD + CVD, 0.96; 95% CI, 0.62-1.51, P = .88). CONCLUSIONS AND RELEVANCE Compared with patients with PAD alone, the risk of major adverse cardiac events and lower-extremity revascularization increased with multiple vascular bed involvement. There was no clear increased risk of bleeding associated with polyvascular disease.
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| 21. |
- Hess, C. N., et al.
(författare)
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A Structured Review of Antithrombotic Therapy in Peripheral Artery Disease With a Focus on Revascularization A TASC (InterSociety Consensus for the Management of Peripheral Artery Disease) Initiative
- 2017
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 135:25, s. 2534-2555
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Tidskriftsartikel (refereegranskat)abstract
- Peripheral artery disease affects >200 million people worldwide and is associated with significant limb and cardiovascular morbidity and mortality. Limb revascularization is recommended to improve function and quality of life for symptomatic patients with peripheral artery disease with intermittent claudication who have not responded to medical treatment. For patients with critical limb ischemia, the goals of revascularization are to relieve pain, help wound healing, and prevent limb loss. The baseline risk of cardiovascular and limb-related events demonstrated among patients with stable peripheral artery disease is elevated after revascularization and related to atherothrombosis and restenosis. Both of these processes involve platelet activation and the coagulation cascade, forming the basis for the use of antiplatelet and anticoagulant therapies to optimize procedural success and reduce postprocedural cardiovascular risk. Unfortunately, few high-quality, randomized data to support use of these therapies after peripheral artery disease revascularization exist, and much of the rationale for the use of antiplatelet agents after endovascular peripheral revascularization is extrapolated from percutaneous coronary intervention literature. Consequently, guideline recommendations for antithrombotic therapy after lower limb revascularization are inconsistent and not always evidence-based. In this context, the purpose of this structured review is to assess the available randomized data for antithrombotic therapy after peripheral arterial revascularization, with a focus on clinical trial design issues that may affect interpretation of study results, and highlight areas that require further investigation.
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| 22. |
- Hess, C. N., et al.
(författare)
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Acute Limb Ischemia in Peripheral Artery Disease Insights From EUCLID
- 2019
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 140:7, s. 556-565
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acute limb ischemia (ALI) is an important clinical event and an emerging cardiovascular clinical trial outcome. Risk factors for and outcomes after ALI have not been fully evaluated. Methods: EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized patients with peripheral artery disease to ticagrelor versus clopidogrel. Enrollment criteria included an ankle-brachial index <= 0.80 or previous lower extremity revascularization. Patients were grouped according to the primary outcome, postrandomization ALI hospitalization. Baseline factors associated with ALI were identified using Cox proportional hazards modeling. Models with ALI hospitalization as a time-dependent covariate were developed for secondary outcomes of major adverse cardiovascular events (myocardial infarction, cardiovascular death, ischemic stroke), all-cause mortality, and major amputation. Results: Among 13 885 patients, 1.7% (n=232) had 293 ALI hospitalizations (0.8 per 100 patient-years). Patients with versus without ALI were younger and more often had previous peripheral revascularization and lower baseline ankle-brachial index. Treatment during ALI hospitalization included endovascular revascularization (39.2%, n=115), surgical bypass (24.6%, n=72), and major amputation (13.0%, n=38). After multivariable adjustment, any previous peripheral revascularization (Hazard Ratio [HR] 4.7, 95% CI 3.3-6.8, P<0.01), baseline atrial fibrillation (HR 1.8, 95% CI 1.1-3.2, P=0.03), and baseline ankle-brachial index <= 0.60 (HR 1.3 per 0.10 decrease, 95% CI 1.1-1.5, P<0.01) were associated with higher ALI risk. Older age (HR 0.8 per 10-year increase, 95% CI 0.7-1.0, P=0.02) and baseline statin use (HR 0.7, 95% CI 0.5-0.9, P<0.01) were associated with lower risk for ALI. There was no relationship between randomized treatment to ticagrelor or clopidogrel and ALI. Among patients with previous revascularization, surgical versus endovascular procedures performed more than 6 months prior were associated with ALI (adjusted HR 2.63, 95% CI 1.75-3.96). In the overall population, ALI hospitalization was associated with subsequent MACE (adjusted HR 1.4, 95% CI 1.0-2.1, P=0.04), all-cause mortality (adjusted HR 3.3, 95% CI 2.4-4.6, P<0.01), and major amputation (adjusted HR 34.2, 95% CI 9.7-20.8, P<0.01). Conclusions: Previous peripheral revascularization, baseline atrial fibrillation, and lower ankle-brachial index identify peripheral artery disease patients at heightened risk for ALI, an event associated with subsequent cardiovascular and limb-related morbidity and mortality.
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| 23. |
- Li, Wenya Y., et al.
(författare)
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Cold Ionospheric Ions in the Magnetic Reconnection Outflow Region
- 2017
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Ingår i: Journal of Geophysical Research - Space Physics. - : Blackwell Publishing. - 2169-9380 .- 2169-9402. ; 122:10, s. 10,194-10,202
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Tidskriftsartikel (refereegranskat)abstract
- Magnetosheath plasma usually determines properties of asymmetric magnetic reconnection at the subsolar region of Earth's magnetopause. However, cold plasma that originated from the ionosphere can also reach the magnetopause and modify the kinetic physics of asymmetric reconnection. We present a magnetopause crossing with high-density (10–60 cm−3) cold ions and ongoing reconnection from the observation of the Magnetospheric Multiscale (MMS) spacecraft. The magnetopause crossing is estimated to be 300 ion inertial lengths south of the X line. Two distinct ion populations are observed on the magnetosheath edge of the ion jet. One population with high parallel velocities (200–300 km/s) is identified to be cold ion beams, and the other population is the magnetosheath ions. In the deHoffman-Teller frame, the field-aligned magnetosheath ions are Alfvénic and move toward the jet region, while the field-aligned cold ion beams move toward the magnetosheath boundary layer, with much lower speeds. These cold ion beams are suggested to be from the cold ions entering the jet close to the X line. This is the first observation of the cold ionospheric ions in the reconnection outflow region, including the reconnection jet and the magnetosheath boundary layer.
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| 24. |
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| 25. |
- McGreevy, David, 1988-, et al.
(författare)
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Metabolic Response to Claudication in Peripheral Arterial Disease : a Microdialysis pilot study
- 2019
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 58, s. 134-141
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In a pilot study investigate the possible use of microdialysis in the calf muscle to assess the metabolic response to intermittent claudication (IC). In addition, evaluate the simultaneous systemic inflammatory reaction.METHODS: With one microdialysis catheter in the gastrocnemic muscle and one subcutaneously in the pectoral region (as a reference), and a peripheral venous catheter, dialysate and venous blood sampling was performed before, during and after walking on a treadmill to maximal tolerable claudication (controls 10 minutes).RESULTS: A total of 9 participants were recruited, six patients with IC and three healthy controls. At baseline, IC and control subjects did not differ in metabolic findings (glucose, lactate, pyruvate, glycerol) in the gastrocnemic muscle. Subcutaneous glucose concentration was higher in controls. After physical exertion, gastrocnemic and subcutaneous glycerol, lactate and pyruvate concentrations increased in IC subjects. Plasma concentrations of Tumor Necrosis Factor--α (TNF- α), Interleucin-6 (IL-6), Interleucin-1ß (IL-1ß), Hepatocyte Growth Factor (HGF) and Vascular Endothelial Growth Factor (VEGF) were higher in IC subjects at baseline, and TNF-α, (IL-6) and Interleukin-18 (IL-18) increased after walking as did IL-6 and (IL-1ß) in controls. The muscle catheters did not show any signs of causing harm.CONCLUSIONS: Microdialysis can be used to study the ongoing metabolic response during walking and claudication. Our results suggest both an acute local and a systemic inflammatory reaction during development of claudication pain.
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